Consensus Guidelines for Managing Postoperative Nausea and Vomiting

Gan, Tong J.; Meyer, Tricia A.; Apfel, Christian C.; Chung, Frances; Davis, Peter J.; Eubanks, Steve; Kovac, Anthony L.; Philip, Beverly K.; Sessler, Daniel I.; Temo, James; Tramèr, Martin R.; Watcha, Mehernoor F.

doi:10.1213/01.ane.0000068580.00245.95

Cited by 848 publications

(742 citation statements)

References 75 publications

Supporting

Mentioning

669

Contrasting

Unclassified

Order By: Relevance

“…Epidural analgesia has been researched in the context of UAE with promising results but only in case series [17,18] and needs to be evaluated in the context of a prospective randomized blinded study compared to morphine PCA, which is currently the most researched therapy and has been shown to be a useful control. Nausea and vomiting are known to delay discharge from postanesthesia care units [28] and from the hospital after surgery [29]. A greater number of patients in the oxycodone group became eligible for discharge after 24 h in our study, but the result did not reach significance and none required more than a 24 h stay.…”

Section: Discussioncontrasting

confidence: 58%

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

Konstantatos

Kavnoudias

Stegeman

et al. 2014

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

Purpose To evaluate the analgesic efficacy of oral premedication of oxycodone in a group of patients undergoing elective uterine artery embolization under sedation for fibroid disease. Methods Thirty-nine patients (mean age 42.3 years) were prospectively randomized 1:1 to receive 20 mg oxycodone or placebo orally immediately before their procedure. At the commencement of the procedure, patients were provided with a patient-controlled analgesia device for 24 h, programmed to deliver 1 mg boluses of intravenous morphine with a 5 min lockout. Mean visual analog scale pain intensity ratings (0-100 mm) were measured from both groups and evaluated over 0 to 6 h as the primary end point. Other measured parameters included opioid-related side effects and eligibility for discharge (NCT00163930; September 12, 2005). Results Early pain intensity did not vary significantly between the active and placebo groups [mean (standard deviation): 3.2 (2.5) vs. 3.1 (2.2), p = 0.89]. The oxycodone group, however, experienced significantly more nausea (p = 0.035) and a greater incidence of vomiting (p = 0.044). Overall opioid requirement over 24 h, measured as oral morphine equivalent, was greater in the oxycodone group (median [interquartile range]: 64.5

show abstract

Section: Discussioncontrasting

confidence: 58%

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

Konstantatos

Kavnoudias

Stegeman

et al. 2014

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

show abstract

“…From a patient's perspective, postoperative nausea and vomiting is one of the most distressing adverse postoperative outcomes, 26 and its avoidance is a marker of quality anesthetic care. [27][28][29][30] There were 27 reports of patient complaints, which the respondents thought could be related to drug shortages. We have no details surrounding these events, but in two cases, legal action was reportedly taken, suggesting that patients are beginning to be negatively affected by the current drug shortage.…”

Section: Discussionmentioning

confidence: 99%

Drug shortages in Canadian anesthesia: a national survey

Hall

Bryson

Flowerdew

et al. 2013

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Background Canadian physicians are faced with an increasing frequency of drug shortages. We hypothesized that drug shortages have a clinical impact on anesthesia care in Canada. Methods We conducted a self-administered survey of anesthesiologists in Canada using the membership list of the Canadian Anesthesiologists' Society. For survey development, we identified key domains, including types of drug shortages, impact on the ability of anesthesia practitioners to provide general anesthesia care, and impact on patient outcomes. We undertook assessments of face validity, clinical sensibility, and content validity. Respondents were surveyed from January-April 2012. Results Completed valid questionnaires were submitted by 1,187 respondents (61.4%), and 779 (65.7%) of respondents described a shortage of one or more anesthesia or critical care drugs. Changes in anesthesia practice resulting from drug shortages were common; 586 (49%) respondents thought they had given an inferior anesthetic, and 361 (30%) reported administering medications with which they were unfamiliar. Respondents also reported that drug shortages were, at times, responsible for changes in the conduct of patient care, with 28 (2.4%) noting cancellation or postponement of surgery and 92 (7.8%) witnessing a drug error. One hundred sixty-five (13.9%) respondents regarded drug shortages as having prolonged recovery from anesthesia, and 124 (10.5%) viewed drug shortages as resulting in an increased number of postoperative complications, such as postoperative nausea and vomiting. Interpretation Drug shortages are common in anesthetic practice in Canada. This state of affairs may have a negative effect on how anesthesiologists practice anesthesia and may be associated with adverse patient outcomes. 123Can J Anesth/J Can Anesth (2013) 60:539-551 DOI 10.1007/s12630-013-9920-z Résumé Contexte Les me´decins canadiens font de plus en plus souvent face a`des pe´nuries de me´dicaments. Nous avons e´mis l'hypothe`se que les pe´nuries de me´dicaments avaient un impact sur les soins en anesthe´sie au Canada. Méthode Nous avons re´alise´un sondage auto-administreá upre`s des anesthe´siologistes au Canada en nous fondant sur la liste des membres de la Socie´te´canadienne des anesthe´siologistes. Lors de la mise au point du sondage, nous avons de´termine´des domaines cle´s, notamment les types de pe´nuries de me´dicaments, l'impact sur la capacite´des fournisseurs d'anesthe´sie a`offrir des soins d'anesthe´sie ge´ne´rale, et l'impact sur les devenirs des patients. Nous avons e´value´la validite´apparente, la sensibilite´clinique, et la validited u contenu. Les re´pondants ont reçu le sondage entre janvier et avril 2012. Résultats Au total, 1187 (61,4 %) re´pondants ont comple´ted es questionnaires de façon valable, et 779 (65,7 %) de ces re´pondants ont de´crit une pe´nurie d'un me´dicament ou plus utilise´en anesthe´sie ou en soins critiques. Les changements dans la pratique de l'anesthe´sie dus a`des pe´nuries de me´dicaments e´taient courants; 586 (49 %) re´...

show abstract

“…Risk factors for PONV were assessed using predesigned datasheets according to the recommendations of the consensus guidelines for management of PONV [4,18]. Risk factors and calculated mean risks for PONV were evaluated using the simplified risk scoring system devised by Apfel et al [3].…”

Section: Methodsmentioning

confidence: 99%

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

Koh

Chang

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

111

147

View full text Add to dashboard Cite

Background Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime. Questions/purposes We determined (1) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone; (2) whether it reduces postoperative pain; and (3) whether it increases the risk for wound complications in a current multimodal regime after TKA. Methods We randomized 269 patients undergoing TKAs to receive dexamethasone (10 mg) 1 hour before surgery and ramosetron immediately after surgery (Dexa-Ra group, n = 135), or ramosetron alone (Ra group, n = 134). We recorded the incidence of postoperative nausea and vomiting (PONV), severity of nausea, incidence of antiemetic requirement, complete response, pain level, and opioid consumption. Patients were assessed 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours postoperatively. In addition, patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery. Results The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA, although not between 6 to 72 hours.

show abstract

Consensus Guidelines for Managing Postoperative Nausea and Vomiting

Abstract: We present evidence-based guidelines developed by an international panel of experts for the management of postoperative nausea and vomiting.

Cited by 848 publications

References 75 publications

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

Drug shortages in Canadian anesthesia: a national survey

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

Contact Info

Product

Resources

About